Provider Demographics
NPI:1508943747
Name:CHERTOG, RIMMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RIMMA
Middle Name:
Last Name:CHERTOG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 AMAGANSETT DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1184
Mailing Address - Country:US
Mailing Address - Phone:732-970-3875
Mailing Address - Fax:
Practice Address - Street 1:186 E 123RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2211
Practice Address - Country:US
Practice Address - Phone:917-847-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052025-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02769006Medicaid